Let the Health Care Reform Debates Begin, Again

Editorial by Wayne Caswell, Founding Editor, Modern Health Talk

According to Forbes, House Republicans released this week a 37-page draft of their plan to “replace Obamacare and reform entitlements.” To that I say, Let the Health Care Reform Debates Begin, Again.

Even though Obamacare has slowed the rising costs of healthcare as our population ages, significantly more work needs to be done to bring our total costs in line with what other advanced nations pay, and with better outcomes. Doing that – continuing to reform health care – has the potential of cutting our $3.4 trillion/year costs in half, thus saving well over $1 trillion/year. Those savings can then be redirected to other purposes, such as lowering taxes, paying down debt, or making strategic investments in education, poverty, research, and infrastructure. The aim of such reforms is to help all Americans regardless of age, income, or socio-economic status.

But powerful opposition to true reforms comes from within the medical industrial complex that stands to lose over $1 trillion/year in revenue and so spends three times as much on political lobbying as the military industrial complex. It’s important that the public keep House Republicans from being tempted to cave into the lobbying pressure. So what should our goals be?

UPDATE: The medical-industrial complex reportedly has spent $5.36 billion since 1998 lobbying in Washington. That’s even larger than the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by the oil and gas corporations over the same period.

That’s a great place to start – agreeing on a basic set of goals and measurable objectives. Next is to align incentives in a way that supports those goals. The debate, however, begins with whether healthcare is a right, and that could get very political. Means testing is just one option.

Here are some other issues as I see them.

Health as a Strategic Investment – Not only can health care reform cut expenses in half or more while also improving outcomes, but better health leads to more productivity – in school, at work, and in global competition, and that can have a significant effect on GDP.

Keep what works and Fix what doesn’t – Recognize that much of Obamacare has had very positive results, so keep what’s working and improve what isn’t, rather than scrapping it entirely and starting again, because too much change at once is disruptively harmful. Millions of people now have health insurance that never did before. Insurers can no longer deny those with preexisting conditions or cut them off when their care gets expensive. Insurers must now spend at least 80% of premiums on real medical care, and not on marketing, administration and profit.

Health Care versus Sick Care – We must continue moving away from the traditional fee-for-service model that has encouraged doing & spending more, replacing it with a focus on health & wellness. After all, “an ounce of prevention is worth a pound of cure.” This is where the biggest costs savings will come from, but it means breaking the old systems, including what’s taught in medical schools.

Wellness Incentives – Some 80% of healthcare costs relate to chronic conditions influenced by lifestyle decisions, so we need ways to better incentivize healthy behavior, which includes nutrition, exercise and sleep.

Competition – Free-market capitalism doesn’t work for much of health care, such as in emergencies when there’s no time to value-shop for the best care provider, or when hospitals refuse to fully disclose their charges ahead of time.

Delivery versus Payment – These are separate issues. Obamacare has done a reasonable job in encouraging more competition among payers. Extending that might include encourage insurance competition across state lines. Little so far has been done, however, about competition among providers.

Exploit Technology – Public policies are needed that cause industry and consumers to embrace, rather than avoid, technologies such as Electronic Medical Records, Big Data analytics, artificial intelligence, robotics, remote monitoring of embedded sensors, and telehealth video consultations. These tech innovations are already disrupting care delivery and traditional business models. And as the pace of tech innovation continues to accelerate exponentially, medical devices will become even cheaper, smaller, more accurate, and easier to use, thus enabling more medical functions to move down-market from doctors in hospitals to consumers at home or wherever they are. The remote monitoring and tracking of real-time sensor data puts this data in context and is helping to identify problems before they grow serious, thus reducing costs even further.

Patent Reform – Obamacare had no provision to allow Medicare to negotiate drug prices, and runaway costs of prescription drugs have been a big driver of overall costs. A central issue of high drug prices is the huge cost of developing new drugs, and the abuse of the patent process that keeps generics off the market. So related to health care reform is the need to also reform the patent and FDA approval process.

At Modern Health Talk (mHealthTalk.com) I’ve written a lot about health care reform from the perspective of a consumer advocate, technologist and futurist. For examples, see https://www.mhealthtalk.com/tag/public-policy/.

About Wayne Caswell, Founding Editor

As a consumer advocate, technologist, futurist and marketer with IBM, Dell, Siemens and my own consulting firm, I know the positive effect that digital technologies can have on society, as well as the challenges of adopting them. I introduced IBM to the Digital Home market before retiring after 30 years when the company got out of consumer markets. After IBM, I established CAZITech Consulting, held leadership roles in industry groups developing Wireless and Home Gateway standards, volunteered with the FCC Consumer Advisory Committee, successfully lobbied the Texas legislature to protect the rights of municipalities to install public Wi-Fi networks, co-founded a nonprofit consumer advocacy to enact new consumer protection laws and abolish an abusive state agency, and founded Modern Health Talk. I can be reached by email or at 1-512-507-6011.